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O Shd


1st visit sidelying ER (or standing w/same motion), prone ER, empty or full can
add on 2nd visit horizontal abd w/scap retract & maybe push-up +
add on 3rd visit rows
stretch pec stretch in corner
synovial jts GH, AC, SC
GH (glenohumeral jt) head of humerus in glenoid
glenohumeral lig limits ant displacement & ER (superior, middle, inferior)
coracohumeral lig limits flex & ext
SC (sternoclavicular) jt ligs ant sternoclavicular, interclavicular (not articular fibrocartilage disc), SC jt glides during elevation, depression, protraction & retraction of scap
AC (acromioclavicular) jt ligs acromioclavicular, coracoclavicular (conoid & trapezoid), very small gliding mvmts during scap mvmts
bursa of shd can be called subacromial or subdeltoid bursa
jt capsule large, loose, inferiorly taut/superiorly folds upon self, very redundant. lined w/synovial tissue. inc the tendon of long head of biceps. tendons of cuff & GH lig support the jt capsule & provide stability
glenoid labrum deepens glenoid, fibrocartilage ring. if torn can be traumatic or degenerative. it's an avascular area, if torn prob needs sx
capsular pattern limited ER, ABD, IR. arthrokinematics, end feel-springy (capsular is normal), convex moving on concave
rx capsular pattern passive stretching & jt mob
mm of shd infraspinatus, teres minor, subscapularis, deltoid, coracobrachialis, pectoralis, biceps, triceps, pec minor
pec major O-med 1/3 of clavicle, sternum, costal cartilage of 1st 6 ribs. I-lat lip bicipital grv of humerus. A-shd add, IR, hor ADD, shd flex 60, shd ext 60. N-lat & med pec
pec minor O-ant surface, 3-5th ribs. I-coracoid process of scap. A-scap depress, protract, down rot & tilt. N-med pec
ant delt O-lat 1/3 of clavicle. I-delt tuberosity. A-shd abd, flex, med rot, hor add. N-axillary
middle delt O-acromion process. I-deltoid tuberosity. A-shd abd. N-axillary
post delt O-spine of scap. I-deltoid tuberosity. A-shd abd, ext, hyperext, lat rot, hor abd. N-axillary
teres minor O-axillary border of scap. I-greater tubercle of humerus. A-shd lat rot, hor abd. N-axillary
infraspinatus O-infraspinous fossa of scap. I-greater tubercle of humerus. A-shd lat rot, hor abd. N-suprascapular
subscapularis O-subscap fossa of scap. I-lesser tubercle of humerus. A-shd IR. N-subscapular
upper trap O-occipital bone, nuchal lig. I-outer 1/3 of clavicle, acromion process. A-Scap elevation & upward rot. N-spinal accessory
middle trap O-spinous processes of C7 thru T3. I-scap spine. A-scap retraction. N-spinal accessory
lower trap O-spinous processes of middle & lower throacic vertebrae. I-base of scap spine. A-scap depression & upwd rot. N-spinal accessory
rhomboids O-spinous processes of C7-T5. I-vertebral border of scap btw spine & inf angle. A-scap retract, elevation, down rot. N-dorsal scap
serratus ant O-lat surface of upper 8 ribs. I-vertebral border of scap, ant surface. A-scap protract & up rot. N-long thoracic
coracobrachialis O-coracoid process of scapula. I-med surface of humerus near midpoint. A-stabilizes shd jt. N-musculocutaneous
biceps brachii O-long head:supraglenoid tubercle of scap. short head: coracoid process of scap. I-radial tuberosity of radius. A-elbow flex, forearm sup. N-musculocutaneous
triceps O:long head:infraglenoid tubercle of scap. Lat head: inf to greater tubercle on post humerus. med head:post surface of humerus. I-olecranon process of ulna. A-elbow ext. N-radial
mm of scapula rhomboids, upper trap, middle trap, lower trap, serratus
ER infraspinatus & teres minor
IR subscapularis
shd observation posture, symmetry, PROM/AROM/end feel, crepitance, tender areas, painful arc
coracoacromial arch formed by: acromion, croacoacromial lig. houses:gr tubercle, rot cuff tendons, biceps tendon, subacromial bursa
impingement pn when arm is overhead & then no pn when arm is down
downward rotation force couple-pec minor, levator, rhomboids
upward rotation force couple-upper traps, lower traps & serratus
scapulohumor rhythm after 30-45 degrees of elevation there is 2:1 ratio. 2 degree GH motion: 1 degree scapular motion
role of posture fwd tilt of scap, over stretched, wk rhomboids, serratus & trap wkness, tight pec minor/maj, levator, compression of subacromial space, faulty mechanics of shd elevation
bicipital tendinitis test pn in ant inner shd w/resisted sup
drop arm test pt unable to lower arm from 90 ABD, complete tear of supraspinatus
apprehension test slowly abd & ext rot-ant glenohumeral dislocation
adsons test TOS
impingement test flex, IR, add humerus so that cuff impinges under acromion-pn indicates impingement
Apley's scratch test opp shd, behind back, behind head
Speeds test resist-GH flex w/elbow ext & palpate bicipital groove for bicipital tendonitis
traumatic shd dislocation forceful abd & rot of the humerus. subscapularis tendon overstretches or tears along w/ant jt capsule & glenoid labrum. often unidirectional & more likely to require sx
non-traumatic shd dislocation laxity of jt capsule w/o trauma. usually bilateral & multidirectional. may respond to rehab
PT management-non-surgical ant dislocation acute phase usually have to follow MD protocol-RICE (may be immobilized in sling for 4 wks), PROM except ER w/ABD, AAROM ER amt frequently ordered by MD, Codmans/mm setting
PT management-non-surgical ant dislocation sub acute phase AROM to wrist & elbow, physical agents for pn/edema, when ordered progress to AAROM, AROM, isometrics & resistive ex for cuff strengthening, cross friction massage, stretching, strengthening but cont to avoid ABD/ER
PT management for general shd instability stretching generally not focus of rx, esp into ER, gen shd strengthening indicated esp RC & scapular mm, correction of poor posture to take stress of soft tissues, may need to modify activity to prevent overuse
Bankart repair labrum & ant capsule reattached to glenoid
capsulorrhaphy (capsular shift) loose capsule pinned or sutured (ETAC-electrothermally assisted capsulorrhaphy)
repair of a SLAP (sup labrum extending ant to post)lesion reattach torn structures (usually labrum & biceps)
ant dislocation-post op rehab wk 1-2-ROM & isometrics/ wk 3-4 begin resisted ex/ some protocols contraindicate ER & ABD for 1st 4 wks post op/ return to activity in 6-9 mos
adhesive capsulitis frozen shd
primary adhesive capsulitis unknown etiology. unknown stimulus produced. profound histological changes in the capsule resulting in fibrosis
secondary adhesive capsulitis minor trauma or episode of inflammation that leads to disuse, tissue shortening & adhesions. onset is gradual & initially pn is the primary complaint, may be related to diabetes, immobilization
adhesive capsulitis S&S pn in lat shd that initially is severe but eventually subsides to dull ache & stiffness, severe loss of motion in capsular pattern. motion is often restricted w/in 2-3 wks. night pn, cant sleep on involved side, empty end feel
adhesive capsulitis PT management acute/subacute pn management AROM/PROM
adhesive capsulitis PT management chronic jt mob, aggressive stretching, strengthening, some require manipulation under anesthesia, many spontaneously resolve but may take 2 yrs
most common cause of shd pn biceps tendonitis
biceps tendonitis S&S tenderness, pn w/stress to tendon (ie strong isometric contraction, sharp twinges on certain mvmt common, esp ext rot, abd) AROM-painful arc common. PROM-generally full
PT management of bicipital tendonitis acute & subacute management w/physical agents and rest. ionto /phono used commonly
PT management of bicipital tendonitis chronic heat, begin AAROM, AROM, resistive, friction massage, mobilization, stretching, must rx underlying cause (abt 80% posture & wkness of scap or RC mm)
bursitis pretty rare, often occurs secondary to impingement or chronic tendonitis
bursitis S&S lat arm pn, may refer to arm, dull ache under delt, hx of chronic tendonitis, AROM-noncapsular pattern, may have painful arc, painful elevation
bursitis rx like tendonitis since causes the same...heat, begin AAROM, AROM, resistive, friction massage, mobilization, stretching, must rx underlying cause (abt 80% posture & wkness of scap or RC mm)
RTC impingement syndrome result of repetitive microtrauma to tissues in coracoacromial space & decreased space between acromion & gr tubercle
RTC impingement syndrome causes usually related to overhead activity such as tennis, military press, painting, swimming, ball throwing, associated w/scapular & RC wkness
RTC impingement syndrome tissues effected long head of biceps, subacromial bursa, supraspinatus tendon
impingement underlying cause is crowding of subacromial space, humeral head migrates superiorly during activity/delt overactive, SS underactive
impingement syndrome S&S superior pn esp w/overhead activity, long hx of pn/microtrauma, painful arc (abd btw 70-120), positive impingement signs
PT management of impingement rx like tendonitis, strengthening of cuff & post scap mm, stretching ok but avoid painful arc, correct functional probs, closed chain ex recommended as well as core strength
RCT (rotator cuff tear) causes loss of subacromal space leads to: DJD, spurs, calcific tendonitis, chronic inflammation/scarring, wking of cuff tendon or mm due to age, microtearing or decreased vascularity, GH or scapulothroacic hypermob, or trauma
RCT (rotator cuff tear) trauma microtrauma-esp deceleration phase of throwing-eccentric contraction, can be classified as complete or incomplete (rx conservatively-same as tendonitis)
RCT (rotator cuff tear) clinical signs + drop arm test-full ABD to ADD-arm drops @ 90, loss of ADL function, wkness, + empty can test, PM pn, pn & wkness w/elevation, jt noise, atrophy
sx repair of RC increase space between acromion & tendon, repair of tear w/sutures-reattachment of tendons if complete, arthroscopy most cases
most post op RC sx protocol physician ordered
SC/AC jt sprain/dislocation type I occurs w/trauma to jt but capsule & ligaments are intact
SC/AC jt sprain/dislocation type II (subluxation) occurs when capsule tears but conoid & trapezoid ligaments are not. these connect the coracoid process & acromion
SC/AC jt sprain/dislocation type III (separation) capsule, ligaments, overlying mm are torn & clavicle is displaced
TSA (total shd arthroplasty) done in cases of severe OA, RA, there is option of hemiarthroplasty, outcome relatively poor w/ severely limited ROM & strength
PT management TSA per MD protocol
complex regional pain syndrome (CRPS) formerly RSDS (shd/hand syndrome)- a neuromuscular disorder of unknown etiology that frequently follows some type of trauma or other chronic prob. may also occur in LE, may last from months to years.
complex regional pain syndrome (CRPS) S&S pn, edema, stiffness, discoloration
complex regional pain syndrome (CRPS) rx pts need anti-inflammatories, steroids, sympathetic blocks, rx is difficult, often of limited effectiveness
complex regional pain syndrome (CRPS)components sympathetic nervous system dysfunction, sensory dysfunction such as burning, motor dysfunction, trophic changes (sweating, loss of hair, shiny, temp change, thick nails)
complex regional pain syndrome (CRPS) type 1 (reflex sympathetic dystrophy)- origin not related to nerve injury
complex regional pain syndrome (CRPS) type 2 causalgia- develops after nerve injury
complex regional pain syndrome (CRPS) dx is 3/4 of ... unduly prolonged or intense pn, stiffness, delayed functional recovery, trophic changes
PT management of CRPS decrease pn, massage for edema, elevation/elastic compression, desensitization, manage limited mob depending on acuity, protect involved & uninvolved jts, contrast bath, ice, heat, compression, TENS, estim, phone, early PROM, AAROM, AROM as tolerated
common sources of referred pn in the shd region cervical spine, referred pn from related tissues
nerve disorders in the shd girdle region brachial plexus in the thoracic outlet, suprascapular nerve in the suprascapular notch, radial nerve in the axilla
Created by: jessigirrl4



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